CPT® Code 45320

Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)

A rigid proctosigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the rectum and the lower part of the sigmoid colon using a rigid endoscope. This procedure is specifically designed for the ablation of tumors, polyps, or other lesions that cannot be removed using standard techniques such as hot biopsy forceps, bipolar cautery, or snare techniques. During the procedure, an obturator is inserted into the endoscope, which is then introduced into the anus and advanced approximately 5 centimeters into the rectum. Once the obturator is removed, the eyepiece is attached to the endoscope, allowing for visualization. The endoscope is advanced further into the rectum, utilizing air insufflation to separate the mucosal folds for better visibility. The scope is maneuvered to reach the rectosigmoid junction and, if feasible, a short distance into the sigmoid colon. After thorough inspection of the mucosa, any identified tumors, polyps, or lesions are targeted for ablation. Ablation is performed using advanced techniques such as laser ablation, where the laser device is carefully delivered through the endoscope to the proximal margin of the lesion. The ablation process begins at the proximal margin and continues as the endoscope is retracted, ensuring that the entire lesion is effectively destroyed. This procedure is crucial for managing lesions that pose a risk of malignancy or cause significant symptoms, providing a minimally invasive option for treatment.